Provider Demographics
NPI:1295031979
Name:BRAZOSPORT PSYCHIATRIC CLINIC
Entity Type:Organization
Organization Name:BRAZOSPORT PSYCHIATRIC CLINIC
Other - Org Name:MATTHEW BRAMS MD ALICE MAO MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:N
Authorized Official - Last Name:BRAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-864-6694
Mailing Address - Street 1:52 FLAG LAKE PLZ
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-6263
Mailing Address - Country:US
Mailing Address - Phone:713-864-6694
Mailing Address - Fax:
Practice Address - Street 1:52 FLAG LAKE PLZ
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6263
Practice Address - Country:US
Practice Address - Phone:713-864-6694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEW BRAMS MD ALICE MAO MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty